The role of radioiodine therapy in benign nodular goitre

For treatment of benign nodular goitre the choice usually stands between surgery and 131I therapy. 131I therapy, used for 30 years for this condition, leads to a goitre volume reduction of 35–50% within 1–2 years. However, this treatment has limited efficacy if the thyroid 131I uptake is low or if the goitre is large. Recombinant human TSH (rhTSH)-stimulated 131I therapy significantly improves goitre reduction, as compared with conventional 131I therapy without pre-stimulation, and adverse effects are few with rhTSH doses of 0.1 mg or lower. RhTSH-stimulated 131I therapy reduces the need for additional therapy due to insufficient goitre reduction, but the price is a higher rate of hypothyroidism. Another approach with rhTSH-stimulation is to reduce the administered 131I activity by a factor that equals the increase in the thyroid 131I uptake. Using this approach, radiation exposure is considerably reduced while the goitre reduction is similar to that obtained with conventional 131I therapy.